Healthcare Provider Details

I. General information

NPI: 1487679841
Provider Name (Legal Business Name): PAUL W PICKARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST
MOBILE AL
36608-1753
US

IV. Provider business mailing address

PO BOX 851417
MOBILE AL
36685-1417
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-3000
  • Fax: 251-342-3043
Mailing address:
  • Phone: 251-342-3000
  • Fax: 251-342-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14818
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15000
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD207394
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: